Attachment_C-_Top_Dental_Procedures.xlsx

This is a dental procedure pricing attachment for the School Board of Polk County, Florida's Group Dental Plan Request for Proposals (RFP #048-PLA-0515). The document outlines a comprehensive list of dental procedures across multiple service categories, including diagnostic services (oral examinations, radiographs), preventive services (prophylaxis, fluoride applications, sealants), restorative services (amalgam and composite fillings, crowns), endodontics (root canals by tooth type), periodontics (scaling and root planing, periodontal maintenance), prosthodontics (fixed pontics and crowns), oral surgery (tooth extractions and impacted tooth removal), and adjunctive general services (sedation, anesthesia, consultations, and occlusal guards).

Bidders are required to provide maximum PPO network fee allowances for each procedure and classify each service into benefit types I, II, III, or IV, with the maximum fee calculated by applying the applicable benefit percentage. The submission must include three plan levels—Low Plan, Middle Plan, and High Plan—with fees and benefit classifications specified for each. Proposals must be submitted in both hard copy and Excel format as specified in the Request for Proposals, with this attachment completed in full as a mandatory component of the bid submission.